Isometric Exercise for Tendinopathy

Tendon pain is the most common gradual-onset, overloading injury.  Mechanotherapy / exercise is the most beneficial treatment option.  

Eccentric exercises have been commonly prescribed over the last decade, following the pain-provoking Alfredson programme of 3 x 15 reps, twice/day.  It sometimes works very well.

The last few years I’ve favoured isometric exercise as an initial treatment - partly because of personal experience with Achilles, patellar, and lateral elbow tendon issues, & recommendation from Jill Cook & Craig Purdham at the AIS.

New research adds some support to isometric exercise as a treatment for tendinopathy, concluding it reduces tendon pain and improves strength.  The authors delve in to all the “hows” & “whys” of how it works in their discussion, and to be honest it’s a bit technical for my understanding.

The research protocol uses  5 reps of a 45 second contraction, at a 70% effort.  I prefer a more gentle contraction of 50% effort, but a longer hold of at least a minute, and I like a larger total volume of at least 10 minutes/day.  Obviously it’s hard to define what the perfect dosage is for exercise, & volume could be adjusted depending on results.

I like isometrics because:

• you don’t need any equipment / you can do them anywhere
• they're easily done for all the common tendinopathies
  
• they can be started straight away, even in the most painful cases
  
• they work well